The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Mar 2010
Review"C3, 4, 5 Keeps the Diaphragm Alive." Is phrenic nerve palsy part of the pathophysiological mechanism in strangulation and hanging? Should diaphragm paralysis be excluded in survived cases?: A review of the literature.
The phrenic nerve arises in the neck. It is formed from C3, C4, and C5 nerve fibers and descends along the anterior surface of the scalenus anterior muscle before entering the thorax to supply motor and sensory input to the diaphragm. Its anatomic location in the neck leaves the nerve vulnerable to traumatic injury. ⋯ Cases of diaphragm paralysis occurring as a consequence of neck trauma are documented in the literature. In some cases, the forces involved are relatively minor and include whiplash injury, occurring in minor motor vehicle collisions, chiropractic manipulation, and compression of neck structures, including a case involving external neck compression by industrial machinery. It is concluded that phrenic nerve palsy might be part of the pathophysiological mechanism in strangulation and hanging, and clinical investigation to exclude diaphragm paralysis in survived cases should be considered.
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Fentanyl is a potent Schedule II narcotic analgesic recommended for use in the management of unremitting pain not controlled by morphine or other opiate/opioid drugs. The danger inherent to fentanyl is its potency (greater than 50-100 times that of morphine) and rapidity of action, causing respiratory depression within minutes of administration. Advisories have been issued on a state and national level to health care providers and through manufacturers' package inserts for patients. ⋯ This number was a marked increase from the 1 to 2 cases occurring annually from 2002 to 2005. All of these 2006 overdoses because of fentanyl involved the transdermal formulation. The investigative data, blood and liver fentanyl levels, and autopsy findings will be presented.
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Am J Forensic Med Pathol · Mar 2010
Case ReportsAccidental intrathecal administration of vincristine.
We describe a case of accidental intrathecal administration of vincristine in a 33-year-old man with clinical diagnosis of acute lymphocytic leukemia. The patient died 20 days after receiving the drug. Clinically, the patient developed acute ascending paralysis with motor and sensory dysfunctions, and respiratory failure. Neuropathological investigation revealed lesions in spinal cord, roots, and cerebellum characterized by rarefaction of the neuropil, axonal, and myelin degeneration, accompanied by macrophagic infiltration.
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Farm tractors are the major cause of occupational fatalities in agricultural regions. Fatalities typically result from being run over or crushed by the tractor, becoming entangled in the moving parts of the tractor, accidents on roadways, and tractor rollovers, which involve the tractor tipping sideways or backwards and crushing the operator. In this study, tractor-related fatalities in the Konya province of Turkey are retrospectively evaluated. ⋯ In 32 (37.2%) of the cases, the deaths due to tractor accidents occurred when the tractor overturned. In 37 (43.0%) of the cases, the tractor-related fatalities involved the passengers and the drivers were involved in 34 (39.5%) of the cases. In conclusion, tractor accidents are preventable and deaths from tractor accidents can be significantly reduced if drivers are required to wear safety belts and helmets and frequent checks are implemented to enforce the ban on carrying passengers.
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Rigor mortis is conventionally a postmortem change. Its occurrence suggests that death has occurred at least a few hours ago. The authors report a case of "Rigor Mortis" in a live patient after cardiac surgery. ⋯ Such an event may be of importance while determining the time of death in individuals such as described in the report. It may also suggest requirement of careful examination of patients with muscle stiffening prior to declaration of death. This report is being published to point out the likely controversies that might arise out of muscle stiffening, which should not always be termed rigor mortis and/ or postmortem.